To define the contribution of aggressive lymphoma treatment to the risk of post-splenectomy septicemia, we investigated the humoral immunity of 44 patients with Hodgkin's disease. Specific antibody against Haemophilus influenzae Type b was significantly reduced (mean, 147 ng per milliliter, P<0.01) in patients receiving combined treatment (radiotherapy and chemotherapy), whereas single treatment reduced titers marginally (chemotherapy) or not at all (radiotherapy). Untreated patients had normal values (396 ng per milliliter), and splenectomy was without effect. In some patients who received combined treatment, titers were reduced to levels seen in infants. IgM levels were likewise normal in untreated patients. Chemotherapy, however, significantly reduced IgM levels (P<0.025), an effect potentiated by prior splenectomy. IgG, IgA, alternate-pathway activity, C3, C4 and CH50 were all normal or elevated. Aggressive treatment with chemotherapy and radiation impairs humoral defense against encapsulated micro-organisms, and thus magnifies the risk of post-splenectomy septicemia in patients with Hodgkin's disease. (N Engl J Med 297:245–248, 1977) The increased risk of overwhelming sepsis in young children subjected to splenectomy has been recognized for many years.12 More recently, in older children and adults with splenectomy for staging of Hodgkin's disease, aggressive treatment of the underlying lymphoma has been shown to play a major part in the late risk of “post-splenectomy” septicemia.34 The responsible organisms (pneumococcus and Haemophilus influenzae) are those also frequently associated with defects in humoral immunity. The present investigation was undertaken to define treatment-induced immune deficits that might explain the predisposition to these infections and to delimit high-risk groups. Factors studied in addition to specific antibody.
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